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Celiac Disease

Clearing Up the Allergy Confusion

Celiac disease is not food allergy.
Rather, it is a disease
of the digestive system that
results in damage to the small intestine
by interfering with the absorption of nutrients.
Celiac disease is unique in that
one specific food component – gluten
– has been identified as the main culprit.
Gluten is the common name for proteins
in specific grains that are harmful
to persons with celiac disease. These
proteins are found in all forms of wheat
(including durum, semolina, spelt, kamut,
einkorn, and faro), and related grains,
such as rye, barley, and triticale. Damage
to the surface of the small intestine
is caused by an immunologically toxic
reaction to the ingestion of gluten.

Celiac disease is often confused with
food allergy because so many of the
grains and wheats that can cause food
allergies are the same ones that cause
celiac disease. A common symptom and
side effect of celiac disease is Dermatitis
Herpetiformis, a severe, itchy skin
rash (not a skin allergy) of small dark
spots that develop on the hands, arms,
and legs of people with celiac disease.

Celiac disease is genetically passed
down from generation to generation. It
is estimated that up to 1 in every 133
persons in the U.S. is affected. Family
members can be tested for celiac disease
even if symptoms are not apparent.
People with immunoglobulin A (IgA)
deficiency should consult with an
experienced pathologist to ensure
proper diagnosis.

Celiac disease is often confused with food allergy
because so many of the grains and wheats that
can cause food allergies are the same ones that
cause celiac disease.

The only treatment for celiac disease
is lifelong avoidance of foods with
gluten. When gluten is removed from
the diet, the small intestine will start
to heal and overall health is improved.
Medication is normally not required.
Consult your physician regarding specific
nutritional supplementation to
correct any deficiencies.

All people with celiac disease should
be monitored by their physician to
ensure compliance with and response
to the gluten-free diet. Dietary compliance
decreases the likelihood of
osteoporosis, lymphoma, and other
associated illnesses.

Adapting to the gluten-free diet requires
some lifestyle changes. It is
crucial to read labels, which are often
imprecise, and learn to identify ingredients
that may contain hidden gluten. Be
aware that hidden gluten can be found
in some unlikely foods, such as cold cuts,
soups, hard candies, soy sauce, many
low fat or nonfat products, and even
licorice and jelly beans.

Wheat Allergy Gluten allergy is
often confused with celiac disease or
other digestive disorders. However,
wheat allergy refers to adverse reactions
involving immunoglobulin E (IgE) antibodies
to one or more proteins found
in wheat, including albumin, globulin,
gliadin, and glutenin (gluten). (The majority
of reactions involve albumin and
globulin. Gliadin and gluten are rarer.)
Allergic reactions to wheat may be
caused by eating foods with wheat or
even by inhaling flour containing wheat.

Allergic reactions to wheat usually begin
within minutes or a few hours after
eating or inhaling wheat. The most
commonly reported symptoms seen
with this kind of allergy include atopic
dermatitis (eczema), urticaria (hives),
asthma, allergic rhinitis, anaphylactic
shock, and digestive symptoms.

Diagnosis may be easy if a person
always has the same reaction after eating
wheat-containing food, but more
often, the diagnosis is difficult because
wheat is a common food. Diagnosis
usually entails a detailed medical evaluation
with laboratory tests (RAST,
skin-prick testing). Elimination-challenge
testing remains the most
reliable method of diagnosis.

Avoidance of wheat and wheat-containing
foods is the first step in the
treatment of wheat allergy. Wheat allergic
people who have sensitivity to
gluten (or gliadin) should avoid other
gluten-containing cereals, such as oats,
rye, and barley. However, because wheat
is a common food product, wheat elimination
diets can be difficult to maintain.
Children on wheat-restricted diets are
severely limited in their selection of
foods. Alternatives may be found in
special health and diet stores and
restaurants.

As with most allergies, avoidance
is key. Make sure to read all labels for
foods, medicines, cosmetics, creams,
and ointments that may contain any
type or amount of wheat. A history
of allergic reactions shortly after exposure
to wheat might suggest an
allergy. However, this should be confirmed
with a skin prick test or RAST.
Talk to your doctor about a complete
diagnosis.